We recently had the opportunity to interview Dr. Eitan Kohan and learn more about his background and experiences using InSet™ Systems from Shoulder Innovations in his practice as an orthopedic surgeon.
An edited version of our interview led by David Blue follows.
David Blue:
Thank you for joining us today. Would you please share your background, including how you became involved in healthcare and specifically orthopedics?
Dr. Eitan Kohan:
I was always interested in math and science topics, but going into college I didn’t know exactly where to go with that. While trying to figure it out, I began exploring the healthcare field and as I pursued that path, I discovered how much I truly connected with it and enjoyed it.
When I entered medical school and started working in the anatomy lab, I became fascinated with the form and function of everything in orthopedics. It was something I that just intuitively made sense and I gravitated toward that. The deeper I delved into it, the more I loved it.
David Blue:
What attracted you to shoulder as a sub-specialty?
Dr. Eitan Kohan:
My interest in shoulder surgery began during my residency. Initially, I didn’t even know that shoulder surgery was a subspecialty; I thought it was just part of sports medicine. However, my first orthopedic rotation as an intern was on the shoulder service, and I really connected with the physicians there.
I found the surgeries, pathologies, and patients incredibly interesting, and I latched onto the shoulder specialty at that point. I had great mentors whom I wanted to emulate, which fueled my passion for the field. The more I learned about it, the more I loved it, and my interest has only grown since then.
David Blue:
How long have you been using the InSet™ system, and how did you become familiar with it?
Dr. Eitan Kohan:
During my residency, I first encountered the concept of the InSet™ glenoid with Dr. Jay Keener. He used it for patients with severe deformities, where he was concerned that an onlay glenoid might be prone to loosening, yet he still wanted to perform an anatomic shoulder replacement. I saw a similar approach during my fellowship with Dr. Gerry Williams, who also used the InSet™ glenoid for severely deformed glenoids.
My initial plan coming out of fellowship was to use the InSet™ glenoid for severely deformed glenoids in patients for whom I wanted to perform an anatomic shoulder replacement, similar to how my mentors used it. As I learned more about the system and its capabilities, I began to appreciate that it had more to offer for all patients, not just those with bad deformities. I started using it more frequently and have been very happy with its performance for both anatomic and reverse shoulder replacements.
David Blue:
What are the benefits you’ve recognized in utilizing the InSet™ Shoulder System?
Dr. Eitan Kohan:
First, the instrumentation for both the anatomic and reverse shoulder replacements is so straightforward. Having just one tray for an anatomic procedure is highly appreciated by scrub techs, hospital systems, and ambulatory surgical centers (ASCs). Adding just one extra tray for a reverse procedure ensures that everything needed is readily available. The simplicity and compact footprint of the instrumentation are key benefits.
Using smaller implants means the instrumentation is less bulky, making it easier to achieve good glenoid exposure. This is particularly advantageous in cases with significant deformity or muscular patients, where smaller instrumentation can simplify the procedure.
Second, the robust fixation and bone preservation are tremendous advantages. The “manhole cover” theory applies here, where you only need to ream two millimeters but still achieve strong fixation while preserving the entire peripheral rim of bone. This helps minimize loosening or the “rocking horse” phenomenon associated with larger onlay components.
Third would be relative to the reverse shoulder system. As I mentioned earlier, my initial interest in Shoulder Innovations was for the InSet™ glenoid, but I’ve grown to appreciate the reverse system as much or possibly even more. The base plate is relatively small, at just 24 millimeters, and provides the same InSet™ support as the anatomic side. It features six peripheral screw holes, allowing flexible placement and strong fixation without risking damage to the scapular spine.
The augments are also a significant advantage. They are easy to use, fit well, and require no additional trays. You can secure four or more screws with an augment while avoiding drilling into the scapular spine.
Another benefit of the reverse system is the hollow backside of the glenosphere. This design means you don’t need to ream away all the peripheral bone, unlike some other systems with a flat backside. You can place the base plate and use a peripheral reamer to create a “racing track” for the glenosphere, preserving more bone.
David Blue:
Do you have any tips or pieces of advice that you would give other surgeons if they were using the system for the first time?
Dr. Eitan Kohan:
One of the most important aspects is to do thorough surgical planning in advance. The ProVoyance software for 3D surgical planning is excellent, allowing you to experiment with different implants, see how they fit, determine the optimal placement for the guide pin, and explore various augments. You can also assess the type of peripheral rim you’ll achieve by reaming to a certain depth.
Understanding these elements before entering the operating room is critical. ProVoyance makes this planning process straightforward and effective, providing valuable insights and confidence for the actual procedure.
David Blue:
Do you have any closing thoughts today?
Dr. Eitan Kohan:
I came for the InSet™, but I stayed for the entire system.
Shoulder Innovations provides an excellent replacement platform, not just because of the implants but also due to the trays, the instrumentation, and the people behind it. The designers of this system have extensive experience, having previously developed implants for other companies that are still in use today. They took all their knowledge and expertise to create and improve this system.
Great implants, supported by a great system, and an outstanding team continuously seeking improvements. Their dedication and expertise truly show in the quality of the shoulder replacement products.
Dr. Eitan Kohan is an orthopedic surgeon in Paramus, NJ